A Gold Standard Time to Diagnosis in Axial Spondyloarthritis

I have been pushing the fact that delay to diagnosis in Axial Spondyloarthritis (AxSpA) is a big problem. NASS are way ahead of me and have started a campaign to bring that delay to diagnosis down from 8.5 years to 1 year… (On a personal level I think I might get done out of a job here but that’s not the point…)

This is a huge ambition and EVERYONE needs to help.

Here is the full information – https://nass.co.uk/get-involved/gold-standard/

You can fill out the consultation process here https://www.surveymonkey.co.uk/r/Gold-Standard-NASS-Consultation

For Therapists in all MSK settings we need to make sure we start being aware now and passing any knowledge on to our colleagues. NASS have identified 4 Delays to diagnosis which are:

Delay 1: People do not know that axial SpA may be a cause of their chronic back pain

Delay 2: General practitioners (GPs) may not recognise features of Axial SpA

Delay 3. People may be referred to non-rheumatologists who may not promptly recognise Axial SpA

Delay 4. Rheumatology and radiology teams may not optimally request or interpret investigations

For us as Therapists Delays 2&3 are where we can make a significant difference. Remember that GPs are often times not the first clinician to see this patient as they masquerade as an MSK condition so may attend a physio, osteopath or other MSK clinician first. Whether we are sat in GP surgeries directly as a First Contact Practitioner, private practice seeing a patient before medical screening or having received a referral we need to be at the top of our game to make sure we do the best for our patients. Below I have listed what we need to do to make sure we don’t contribute to any delays and just as importantly, help others around us be better too.

Delay 2: General practitioners (GPs) may not recognise features of Axial SpA

Be aware of the signs, symptoms and risk factors for AxSpA
Be aware of the associated co-morbidities for AxSpA
Write detailed and referral letters with relevant clinical information and reasoning
Share case studies with peers and colleagues
Understand investigations required for AxSpA
Encourage peers and colleagues to complete points 1-5

Delay 3. People may be referred to non-rheumatologists who may not promptly recognise Axial SpA

Understand the referral pathways locally for suspected AxSpA conditions
Be aware of referral criteria locally for suspected AxSpA conditions
Ensure referral letters are clear and unequivocal that a Rheumatology Referral is warranted
Educate patients and provide written documentation as required to ensure they corroborate referral request
Encourage colleagues and peers to be aware of points 1-4

As mentioned above, I have been trying to push some of this information over the last few years so I have some information:

As blogs